Diarrhea is prevalent; nearly everyone in the world has had it at least once. And it is not free of complications as blood in the stool. This article contains insights from a doctor about how this common condition definition, causes, symptoms, complications, treatment, and a little more.
What is diarrhea?
Diarrhea or diarrhoea is what occurs due to the impairment of the intestine when processing the stool. The factors that bump the stool formation will cause a diarrheal illness and are several, like the diet, allergies, inflammatory and infectious diseases, and more.
Continuous activity of the intestines forms the stool. They absorb and discharge various substances and water throughout the way, and the bowel movement shapes the stool appearance. After many hours of this process, what once was food would go out of the body as stool.
The scientific community has thoroughly analyzed the stool over time. To the point that there is a tool, the “Bristol Stool Chart” (see the image below), that helps them to interpret the stool aspect, and determine what is probably affecting the body if it is not looking normal. It is a scale in which the more dehydrated stool has a round shape, and it is in association with constipation. On the contrary, in diarrhea, it loses its firmness due to the intestines inflammation that affects the reabsorption of water.
If there is any factor causing the intestine to fail at its job of reabsorbing water, then the water would continue through the intestinal passage with the stool, causing diarrhea. However, this is not that simple; several mechanisms exist for increasing the water in the intestinal path by harmful means. Some of them even cause the intestines to uncontrollably discharge water, which has the term “secretory diarrhea.” Others, by limiting the absorption of food and electrolytes, prompt the drag of water to the intestinal passage, this mechanism is known as “osmotic diarrhea.”
How is acute diarrhea defined?
Acute diarrhea is a change in your routine defecation habit, and it may change towards watery or just a loose consistency. For being diarrhea, the defecation with these changes must occur a minimum of three times a day and for implying acute, a duration lesser than 14 days.
Furthermore, to complement the diarrhea definition, there is one unutilized by the doctors, although useful in some cases. In theory, if you could measure the weight of your stool, of course, you can, but it is not a common practice at least for adults. The diarrhea is also defined as the production of more than 200 grams of stool per day by an adult, for children, it is different. Also, when diarrhea lengthens between 14-29 days and more than thirty days, the names change to persistent diarrhea and chronic diarrhea, correspondingly. This division is important because they have different causes, symptoms, and possible outcomes.
Diarrhea could be either a disease or be present as a concurring symptom of another one, as it is usually the case for acute gastroenteritis. This condition involves inflammation of nearly all the digestive tract (stomach, small intestine, and large intestine), and not only the intestine as it happens in diarrhea. Therefore, the inflammation of gastroenteritis leads to a generalized disorder of diarrhea plus other symptoms as vomits that implies a different diagnosis to your doctor.
What causes it?
Infectious diarrhea is the most common scenario. Beginning with viruses, bacteria, and parasites, they infect 70%, 20%, and 10% of the cases, respectively. However, other factors could prompt inflammatory diarrhea, such as drugs, allergies, and surgical conditions.
Food poisoning happens when people consume food that has either bacteria or other microorganisms or their toxins. When the toxins prompt diarrhea, it is usually mild to moderate and self-limits. However, when the contamination had microorganisms, it is a way of acquiring harmful germs that could even threaten life with a severe infection.
The two most important causes of viral diarrhea are rotavirus, and norovirus, with the former affecting mostly children and the latter people of all ages. However, other viruses also cause diarrhea as adenovirus, astrovirus, coronavirus, picornaviruses, and hepatitis A and E viruses.
Bacteria are the second leading cause. They also have many bacteria as possible triggers such as e Shigella, Salmonella, Campylobacter, diarrhoeagenic Escherichia coli, pathogenic Vibrio, Yersinia, and Clostridium difficile.
Parasites such as Cryptosporidium and Giardia lamblia, even though to a lesser extent. They are an important cause, even more in Africa and Latin America; therefore, of travelers’ diarrhea. Americans or overall tourists going to these or other places can acquire them.
Irritable bowel syndrome is a condition that emerges with no organic or identifiable cause, and it is in high association with stress. This disease has diarrhea in alternation with constipation and is becoming with time more common among the population. People with lactose intolerance cannot digest milk or milk-derived food; they can present with an acute onset of diarrhea without an infectious cause.
What causes diarrhea with blood in stool?
There are infectious and noninfectious causes of it, and they vary between children and adults. The circumstances without infection comprise several possible reasons, but the most important include inflammatory bowel disease (Crohn disease or ulcerative colitis), colon cancer, or hemorrhoids.
The infectious root is by far the most common cause of bloody diarrhea. And it could be by the three types of microorganisms, either bacteria, virus, or parasites, with a predominance of the former.
For acquiring any of these microorganisms, it is mostly by contamination of food that could be either spoiled or was handled without hygiene measures. Just by applying minimal standards of hygiene, it is possible to prevent many of these infections successfully.
How it differs the inflammation of the small from the large intestine?
Based on the stool characteristics, a doctor could tell if the diarrhea is coming from the small or large bowel. And it is crucial because these microorganisms previously mentioned that cause diarrhea are within one or another, or sometimes both intestines. So knowing these differences would help to understand what is the cause of the diarrheal episode.
Diarrhea coming from the small intestine appears watery, opposite to the bloody or mucoid appearance of the large segment. It produces more massive volumes of stool, and even though the frequency is increased in both of them, the large intestine causes a bunch more of defecations per day. The small intestine’s diarrhea could have slight traces of blood but never a vibrant and gross blood typical of the large intestine.
Furthermore, the germs affecting the small intestine, are usually viruses, and bacteria that are not that severe. On the contrary, the ones in the large intestine, include very invasive bacteria, or parasites. Therefore, being more dangerous, most of the time, diarrhea coming from this intestine can cause complications.
Why is it important to know the cause?
Because the source is in strict relation to bleeding or complications in patients, in most cases, acute diarrhea is a mild and transient disease that not last more than a few days.
It will entirely depend on the underlying characteristics of the patient, the organism implicated, and the severity of the symptoms. For example, flatulence, in association with foul-smelling, highly suggests infection by Giardia lamblia. While viruses tend to show whole-body symptoms such as fever, nausea, or vomits and much often are considered mild.
On the contrary, diarrhea presentation with high fever and bloody stools suggest highly invasive and harmful bacteria such as salmonella, shigella, campylobacter, enteric viruses as cytomegalovirus, or adenovirus, harmful parasites as Entamoeba histolytica or a particular bacterium called C. difficile. In light of this, acute diarrhea indeed can cause bleeding, and when it occurs is due to a very invasive and harmful microorganism that needs assessment.
You may want to see: Acute Gastritis
What are the symptoms of acute diarrhea?
Many symptoms can exist with acute diarrhea either locally as diarrhea manifestations, and as widespread throughout the body as fever. The local symptoms encompass the urgent necessity to defecate or the feel of needing to defecate even more when you just did.
Regarding the widespread or systemic manifestations of diarrhea, the list includes fever, nausea, vomits, flatulence, abdominal pain, abdominal cramps, increased bowel movements, and bloating.
Furthermore, the most crucial entity in diarrhea is dehydration. It is a leading complication causing death, most frequently in the children and the elderly worldwide. The severity of the symptoms as the dryness of the mouth, thirst, and the absence of teardrops require a systematic assessment by a doctor and family members to avoid its awful developments.
The dehydration classification is in mild, moderate, and severe. It is worthy to say that by knowing these alarm signs, lives can be saved. The soft display of the condition has a general peaceful patient, with their eyes looking normal, tears present, moistened mouth, and drinking water naturally. While in patients with moderate or severe dehydration, the symptoms that appear should raise the alarms. The patient is restless or dormant, the eyes start to sink, absence of tears, dry mouth, thirsty, or poorly drinking water. Those are all signs of alarm that for preventing them is only a matter of drinking sufficient water.
Could I have even more symptoms?
Yes, it is usual that diarrhea is just a part of a more prominent disease. So, it is possible to experience other symptoms nonrelated to diarrhea. For example, hyperthyroidism is a source of diarrhea. So a patient with it concurrently expresses diarrhea and other symptoms like heat intolerance or weight loss.
Other conditions as malabsorption syndrome also trigger other symptoms. This disease causes the patient to have poor nutrition, and all that it carries. It would include weakness, fatigue, failure to thrive, and anemia. Another disease that is inflammatory causes both local and widespread symptoms, as Crohn Disease. This illness could cause diarrhea with or without blood, and systemic manifestations as growth failure or malnutrition.
What are the possible complications?
It would depend on the underlying cause, but let me introduce some to you. Dehydration, as I said earlier, is one of the most common causes of death worldwide in specific populations. Some of those infections could cause perforation of the intestine, organ failure, and more. If not adequately managed, diarrhea could compromise life, even more in population with a weakened immune system. This high-risk population includes people taking steroids, or having a debilitating disease like cancer or diabetes.
How the doctor diagnose diarrhea?
It is important to remember that most of the diarrheas do not get tested because they are watery and self-limited. In those scenarios, an assessment of your doctor would be more than enough to start treatment. However, patients’ bloody diarrhea, severe symptoms, dehydration, or high-risk population would require an in-depth assessment.
There is an exhaustive list of available exams for the patient; however, the doctor will indicate only a few. This indication is in light of the difference between the exams; one is broad and serves as a guide. And the other types of exams are for determining a specific cause. For example, most of the viruses require special immunologic exams for determining their presence within the stool.
The first exam would always be a stool analysis; it is fast, reliable, and cheap. It serves to guide the diagnosis towards a specific cause, or even do an early discard of a severe condition. This exam could tell if the patient has an infection by a viral or bacterial microorganism. Therefore, determining the necessity or not of antibiotics. For example, the presence of fecal leukocytes in this exam is a marker that highly suggests the presence of invasive bacteria or another severe condition. However, the absence of that marker does not discard either the presence of harmful bacteria.
Then, the second exam unless the patient’s characteristics tell otherwise is a stool culture. This study is used in severely ill patients or with bloody stool, severe dehydration, symptoms longer than seven days, and high-risk populations. The ideal stool sample for this exam has less than two hours from the defecation; if not, it needs refrigeration at 4 °C. Despite the low capacity of this study to yield positive results, when it does, they are handy.
What is the treatment for acute diarrhea?
It depends on what is causing it, either a virus, bacteria, or parasite. Also, the rehydration treatment is thought to replenish the water that was lost in the many episodes of watery diarrhea.
First, the therapy needs to be via the mouth (oral rehydration) if the patient is not vomiting. For the treatment is used a particular oral rehydration solution that you can buy at any pharmacy or even craft it at home. If the oral rehydration therapy fails, then it would have to be by an intravenous catheter within an arm’s vein. Anti-motility drugs are not a recommendation; please avoid them without consulting your doctor.
The doctor would need to determine specific treatment, two essential medical exams, a stool-sample analysis, and bacteria culture. Please remember that bacteria are the second most common cause of this condition; therefore, these diagnostic exams would be enough to direct therapy in a significant proportion of the cases. Nevertheless, if not, there are other specific exams, frequently for parasites.
The patients that do not have severe symptoms would have treatment at home. However, most of these patients with acute diarrhea and bloody stool would require directly to the vein antibiotic with close management by a physician.
Antidiarrheal medications are used jointly with the antibiotic to treat bacterial infections. It would depend on the presence or not of bloody stool which to choose, from loperamide or bismuth subsalicylate (BSS). The use of antibiotics when they are not strictly needed can be very harmful to the patient, so your doctor will be careful of using them. Nevertheless, sometimes they are a formal indication to help fight the body the possible infection. An extensive list of them is currently employed, depending on the likely cause that the doctor suspects.
Is acute diarrhea preventable?
It is possible to prevent most of acute diarrhea with common-sense measures. These actions comprise good hygiene with good hand washing, cleanliness when preparing the food, and clean water.
Then there are other measures for preventing the condition thanks to medical advancements as vaccines. Their effectiveness and safety are no matter of discussion with worldwide approval for rotavirus, typhoid fever, and cholera. And others are currently under thorough research.
What is traveler’s diarrhea?
Traveler’s diarrhea is diarrhea that begins when traveling abroad and consuming contaminated water or food from the other country. Despite the symptoms being very bothersome, it is usually a mild disease that would pass within a few days.
This type of diarrhea represents a global problem with a significant impact on the financial and healthcare system of both countries. Even though through worldwide sanitation measures, it has lowered within the years, it continues to be a problem of these days, appearing annually as a cause of disease.
Nevertheless, current studies show that the cause of traveler’s diarrhea is mainly by a bacterial infection. So scientific efforts towards this ailment focus on defining treatment that eliminates specific bacteria to diminish symptoms length or possible complications.
This condition can receive either preventive or actual treatment. Prophylactic or preventative treatment should not be used unless a patient has a high risk of developing complications of this disease. The prevention could be with BSS, and if it is going to be an antibiotic, rifaximin.
The treatment would depend on the severeness of diarrhea. Firstly, mild diarrhea should not receive antibiotic treatment, although it can use BSS or antimotility medication. Secondly, moderate diarrhea may include antibiotics as a treatment plus antimotility drugs. And thirdly, severe diarrhea demands an antibiotic regime, which can be a unique dose or established treatment. It is preferred azithromycin, although there others that can function as well.
What could I do if I am experiencing symptoms?
I have this tool; it is an acute diarrhea symptoms checker, which would help you to find out how likely it is that your change in defecating habits is indeed acute diarrhea. It is free and would only take you a few minutes.